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Medical Aid

Medical Aid Assist offers a range of services in 
medical aid, insurance and estate planning.

Join or Change your Medical Aid Or appoint us as your advisor

Medical Aid Assist will assist you with your Medical Aid

Why?

  • better and professional advice
  • get better benefits and premiums
  • compare what you have with what’s available
  • know your rights in this industry
  • backup – after sales team for queries

You might not even have!

  • a 3 month waiting period
  • penalties and exclusions

Get your FREE Medical Aid Quote NOW by completing the online Call Back form.

Care Line Group is FAIS compliant, which means Best Advice in favour of you, our valued client.

Rising medical and healthcare costs make it essential that you carefully match your family’s healthcare needs with the solution most suited to your specific requirements.

Factors that should be considered when selecting an appropriate plan for your family should be; benefits offered for hospital, chronic, day-to-day and emergency care. Medical Aid Assist advisers will help you select the best possible medical aid solution for your family’s needs.

Why do you need medical aid?

If you or one of your loved ones lands up in an unforeseen critical situation where medical assistance is required and you don’t have medical aid, you have the following two choices;

  1. You would be taken to a Government hospital and have to rely on them for the necessary treatment OR
  2. You would be taken to a Private hospital and before receiving any treatment, you would be required to pay a deposit that could easily start at R80 000.

To have a suitable medical aid can save you financially.

So you’ve decided to get medical aid, what now?

Before looking for an affordable medical aid, first review your monthly budget and decide what you can afford. Health care is expensive, but paying for your medical aid each month could be made affordable, if you have professional assistance. Most medical aids will advise that you do not join a plan that will cost you more than 10% of your gross income. Remember that you will get a small tax benefit for having medical aid cover, so you should factor this in as well. If you have a large family and many dependents, then your medical aid can be costly and you may exceed this 10% budget.

Let Medical Aid Assist assist you in finding a medical aid that will suit your needs.

Things to think about;

What is your current age?
What is your current age?
Have you been on a Medical Aid and for how long?
Have you been on a Medical Aid and for how long?
What made you unhappy about your previous medical aid?
What made you unhappy about your previous medical aid?
Have you been on a Registered Medical Aid since age 21?
Have you been on a Registered Medical Aid since age 21?
Do you have any chronic illnesses and currently using medications?
Do you have any chronic illnesses and currently using medications?
How many people do you want to join on the Medical Aid?
How many people do you want to join on the Medical Aid?
How much do you want to invest in your Medical Aid?
How much do you want to invest in your Medical Aid?

Is there a specific medical scheme which you want to know about?
Is there a specific medical scheme which you want to know about? 

 

There are a couple of things that come into play in fitting your family with the correct Medical Aid Scheme

Basic Rules Governed by the Council for Medical Schemes and Medical Scheme Act
All Medical Aid Schemes work according to these rules, although some have extended these rules to protect the Scheme, their members and also minimise the risk.

Waiting Periods

a 3 month general waiting period means a period in which a beneficiary is not entitled to claim any benefits. Except if he or she qualifies for a PMB.

Scenario A

Scenario A

Meet Jim he is 35 years old and he has a heart condition

  • Jim wants to apply for a medical aid and has NEVER been on a medical aid before.
  • The new Scheme will impose a 3 month waiting period where he will have to pay the medical scheme contribution without receiving benefits for the first 3 months.
  • He wants a medical scheme that covers 100% unlimited hospital cover.
  • He has to disclose that he has a pre-existing condition on his heart, because it is a pre-existing condition, he will not be covered for any heart related illnesses for the first 12 months.
  • Even though a heart condition is a PMB (prescribed minimum benefits) and can be life threatening as per the medical scheme act. The scheme will not cover it for the first 12 months as the condition is pre-exiting.

Scenario B

Scenario B

Meet Jim he is 35 years old and he has a heart condition

  • Jim wants to apply for a medical aid and has been / or still is with a medical aid for LESS than 2 years without a break of longer than 90 days. 
  • The new scheme may impose a 12 month conditions specified waiting period because he was on a medical aid before.
  • He wants a medical scheme that covers 100% unlimited hospitals cover.
  • He has to disclose that he has a pre-existing condition of the heart, but because he has been on a medical aid before, the new medical aid scheme will cover him on this pre-existing condition. As it forms part of PMB, but he should make use of a DSP (designated service provider) of his new medical scheme to get treatment for anything heart related to ensure cover for 100%  unlimited.
  • Although he will get a 12 month condition specific waiting period his heart condition is a PMB (prescribed minimum benefits) and will be coved by his medical scheme. However a 12 month conditions specific waiting period on non PMB’s such as gout and depression will not be covered in this period.

Scenario C

Scenario C

Meet Jim he is 35 years old and he has a heart condition

  • Jim wants to apply for a medical aid and has been / or still is with a medical aid for MORE than 2 years.
  • He wants a medical scheme that covers 100% unlimited hospital cover.
  • He will have a 3 month general waiting period where all life threatening conditions (PMB’s) in hospital will be covered in this period subject to PMB rules. However all day to day benefits will be paid out of your own pocket.
  • He has to disclose that he has a pre-existing heart condition, but because he has been on a medical aid for more than 2 years without a break of 90 days. His medical aid will cover him on this pre-existing condition.

Condition-specific waiting period means a period during which a beneficiary is not entitled to claim benefits in respect of a condition for which medical advice, diagnosis, care or treatment was recommended or received within the twelve-month period ending on the date on which an application for membership was made;

Prescribed Minimum Benefits (PMB’s)
PMB is a condition that if not treated can result in serious illness or death. This are 270 PMB’s surgical procedures and 25 chronic conditions altogether, for a more defined definition click HERE to see the PMB Summary List

The government has imposed a law to state that any scheme in SA should cover 26 chronic conditions including HIV/AIDS. This 26 is part of the CDL List, which means, Chronic Disease List.

Medical Aid Assist plays a vital role in assisting you the client to choose an appropriate plan to suit your needs.

Addison’s Disease, Asthma, Bipolar Mood Disorder, Bronchiectasis, Cardiac Failure, Cardiomyopathy, COPD/ Emphysema/ Chronic Bronchitis, Chronic Renal Disease, Coronary, Artery Disease, Crohn’s Disease, Diabetes Insipidus, Diabetes Mellitus type 1 & 2, Dysrhythmias, Epilepsy, Glaucoma, Haemophilia, Hyperlipidaemia, Hypertension, Hypothyroidism, Multiple Sclersosis, Parkinson’s Disease, Rheumatoid Arthritis, Schizophrenia, Systemic Lupus Erythematosus, Ulcerative Colitis and HIV/AIDS

Late Joiner Penalties (LJP’s)

If you have never been on a medical aid scheme in South Africa or there is more than 90 days break in cover since the last time you have been on a medical aid, late joiner penalties may be imposed.
You will be penalised on your premiums depending on how long the period is, in which you were not coved by a scheme.

To determine in what penalty band you would fall it is worked out as follows:

YOUR CURRENT AGE Z – (Minus) 35 = X

X (Minus) TOTAL OF CREDITABLE COVERAGE OF A MEDICAL AID AS FROM THE AGE OF 21 TO DATE = ‘Y’

So ‘Y’ will determine your Penalty bands

See table below for penalty bands:

Penalty bands
(Years) not on medical aid

Maximum penalty 
1–4 years 0,05 contribution  (5%)
5–14 years 0,25 contribution  (25%)
15–24 years 0,5 contribution  (50%)
25+ years 0,75 contribution  (75%)

Your shortfall determines your penalty band and a positive will indicate no penalties.

Care Line Group is FAIS compliant, which means Best Advice in favour of you, our valued client.

After taking all the answers you have provided us and all of these scenarios into account we at Medical Aid Assist will suggest a medical aid scheme that will best suit you and your family’s needs.

If you want us to give you a call please fill in the form below and one of our friendly medical aid advisors will contact you, as soon as possible.
This is a no obligation FREE Quote 

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